Women's Health

Question 1

discuss the SIJ

Answer 1

attachment of sacrum, ilium and rest of pelvis

Question 2

parts of posterior pelvis

Answer 2

posterior sacroiliac ligament - sacrum to ilium

sacrospinous ligament - sacrum to ischial spine

sarcotuberous ligament - sacrum to ischial tuberosity

Question 3

compare form closure and force closure

Answer 3

form - interlocking of bones; wedge shaped sacrum bet ilia

force - compressive forces of muscles, ligaments and fascia; passive support to SIJ

Question 4

functions of pelvic floor

Answer 4

support pelvic orgrans and intra-abdmoninal contents

help in continence

help in arousal and orgasm

breathing

preggy and childbirth

Question 5

discuss the pelvic diaphragm

Answer 5

thin funnel shaped sling of fascia or muscle

from symphysis pubis to coccyx and lateral sidewall

forms inferior border of abdominopelvic cavity

Question 6

discuss urogenital diaphragm

Answer 6

strong muscular membrane - traingular ligament

forms triangular ant portion of pelvic outlet

bet sympysis pubis and ischial tub

supports vaginal and urethral orifices

Question 7

discuss pelvic ligaments

Answer 7

not rlly ligaments but are thckening if retroperitoneal fascia

blood vessels, nerves, and fatty connective tissue wrapped with fascia

Question 8

discuss subserous or endopelvic fascia

Answer 8

cont of transversalis fascia (covers transverse abdominis)

Question 9

broad ligaments

Answer 9

thin, mesenteric like double reflection of peritoneum

from lateral pelvic sidewall to uterus

Question 10

cardinal or mackenrodt’s ligaments

Answer 10

from the lateral aspects of the upper part of the cervix and the vagina to the pelvic wall

Question 11

uterosacral ligaments

Answer 11

from the upper portion of the cervix posteriorly to the 3rd sacral vertebra

suports uterus and pelvis

Question 12

what are the superficial PFM

Answer 12

external anal sphincter

perineal body - connection of muscle in the pelvis

puboperineal or tranverse perinei

Question 13

what are the deep PFM

Answer 13

pubococcygeus

illeococcygeus

coccygeus

puborectalis

Question 14

compare the anal sphincters

Answer 14

internal: extension of circular msucle of rectum

external: extension of longitudinal msucle of rectum
- part of levator ani and is voluntary

Question 15

innervations of PFM

Answer 15

pudendal nerve - S2-3

direct branch from S4 - nerve to levator ani

Question 16

discuss pelvic dysfunctions

Answer 16

abnormal function of PFM - hyper or hypotonic

can have prolapse or incontinence - one of the largest issues in women

esp after birth or preggy

Question 17

discuss boat in dry rock theory

Answer 17

ship: pelvic organs

ropes: ligament and fascia

water: PFM support

without water or PFM - ship or organs will sag down or prolapse

di kaya ng ligaments lang to support - overtime ma sstretch and daamge sila

Question 18

discuss soda can theory

Answer 18

PFM helps maintain pressure by pushing upward to support pelvic and abdominal contents

helps core maintain posture

Question 19

factors causing pelvic dysfunction

Answer 19

predisposing - gender, neuro, anatomy, env

inciting - childbirth, trauma, radiation, surgery

promoting - constipation, smoking, obesity, infection, mensctural cycle, medicine, menopause

decompensating - aging, dementia, disease

Question 20

pelvic floor exam procedures

Answer 20

vaginal and anal exam/palp

neuro exam of lower sacral segments

assessment of internal structures

electromyography

vaginal squeeze pressure

pelvic floor dynamoemtry

ultrasound of pelvic organs

MRI

Question 21

pelvic floor OMTS

Answer 21

PFIQ-7

australian pelvic floor questionairee

pelvic pain questionairre

all numerical and pt will answer

Question 22

discuss stress UI

Answer 22

loss of urine c inc intraabdominal pressure - couging, laughing, sneezing or exertion

common in old or inc parity

Question 23

urge UI

Answer 23

involuntary leakage preceded by urge to void

either spastic bladder - detrusor overcomes sphincter

or

radiation - loos of viscoelasticity of bladder causing early voiding

neurogenic or not (radiation)

Question 24

mixed UI

Answer 24

both SUI or UUI

Question 25

epidem of UI

Answer 25

34% prevalence inc in smoking, high BMI and inc parity high level female athletes - SUI is 41.5%

Question 26

discuss pelvic floor myofascial pain

Answer 26

pain and taut bands that cause refered pain from overuse, improper posture and weakness of PFMs (+) hx of birth trauma and sexual abuse can lead to dyspareunia, painful sex and chronic pelvic pain

Question 27

epidemiology of pelvic MP

Answer 27

22% of women (14-79 y/o) with chronic pelvic pain 70% of women with pregnancy-related pelvic girdle pain 52% of women with chronic lumbopelvic pain that began during pregnancy 25% of community-dwelling adults given birth, and those who are still pregnant

Question 28

discuss pelvic girdle pain

Answer 28

MC cause of back and pelvic pain in preggy bet post iliac crest and gluteal found - SIJ can be mechanical, hormonal, inflammatory or collagen and neural shit

Question 29

significance of relaxin

Answer 29

relaxes uterine musculature predisposes to laxity and hypermob

Question 30

epidemiology of PGP

Answer 30

20% of pregnant hx of LBP, pelvic trauma, parity and workload

Question 31

4 subgroups of PGP

Answer 31

double sided SIJ PGP one sided SIJ pubic symphysis pain

Question 32

discuss pelvic nerve injuries

Answer 32

source of chronic pelvic pain usually: - iliohypogastric - ilioinguinal - genitofemoral - pudendal

Question 33

discuss pudendal nerve injury

Answer 33

urinary incontinence and sexual dysfunction d/t pelvic trauma, bicycle ride, vaginal delivery, anal intercourse

Question 34

discuss iliohypogastric and ilioinguinal nerve injury

Answer 34

Pfannenstiel or low transverse incision during CS

Question 35

discuss genitofemoral nerve injury

Answer 35

during gynecologic surgery

Question 36

what is diastisis recti abdominis

Answer 36

separation of 2 rectus abdominis along line alba inc IRD MC during 3rd trim or in men c large bellies can result to LBP and herniation

Question 37

pathological diastasis

Answer 37

> 2.7 cm at level of umbilicus

Question 38

natural resolution and greatest recovery of DRAM

Answer 38

1 day and 8 weeks after delivery, after which time recovery plateaus

Question 39

kinds of diastisis

Answer 39

open - around perimeter of umbilicus open below navel - below umbilicus open above navel - above umbilicus completely open - along entire length

Question 40

correct way of doing PFM contraction

Answer 40

squeeze around pelvic opening drawing up - inward or cranial lift pigillin ang ihi at tae at the same time cont breathing and check compensation of absd and glutes supine easiest then sit then stand MD 2-3 seconds then 1 set of 10

Question 41

vairations of PFM contraction

Answer 41

kegel c heel slides kegel c toe taps

Question 42

pelvic exercises for hypertonic PFMs

Answer 42

muscles are spasmic happy baby pose - stretch pelvic floor area diphragmatic breathing general relaxation exercise

Question 43

pelvic exercises for hypotonic PFMs

Answer 43

kegels

Question 44

what is the female athletic triad

Answer 44

3 concepts energy deficiency menstrual dysfunction impaired bone health end stage is low energy, hypothalamic amenorrhea and osteoporosis

Question 45

discuss energy deficiency

Answer 45

LEA - starting point from disordered or ED intentional weight loss

Question 46

discuss menstrual dysfunction

Answer 46

eumenorrhea to amenorrhea primary amenorrhea - no peiod yet by 15 secondary - periods absent for 3 mo controlled by HPG - regualtes hormones

Question 47

components that leads to HPG suppression

Answer 47

psychological stress intense exercise disordered eating LEA inc cortisol and dec estro and progesterone = functional hypothalamic amenorrhea

Question 48

health consequences of female athletic triad

Answer 48

affect endocrine, GI, renal, neuropsych, MSK and CV persistent ammenorrhea or luteal deficit = infertile osteoporosis

Question 48

discuss impaired bone health

Answer 48

from disordered eating and low estrogen = vit D and Ca deficinecy

Question 49

discuss primary dysmenorrhea

Answer 49

mesntraul cramps in lower abdomen before or during menstrual cycle 20-90% d/t inc prostaglandins and vasopressin can include nasuea, vomiting, diarrhea, fatigue, fever, HA and lightheadedness

Question 50

discuss gender affirming surgery

Answer 50

vaginoplasty - for transgender women phalloplasty - for transgender men construciton of genitals and dissection of PFM = weakness and sphincter prob

Question 51

SUI from vaginoplasty

Answer 51

16-33%

Question 52

PT for gender reaffirming surgery

Answer 52

PFM PT neovaginal dilation